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[MYCOBACTERIOSIS ASSOCIATED WITH ADMINISTRATION OF BIOLOGICS].

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    Biologics, used for inflammatory diseases, can increase tuberculosis risk. Screening and preventive treatment for latent tuberculosis infection (LTBI) can mitigate this, but careful monitoring for immune reconstitution inflammatory syndrome is crucial.

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    Area of Science:

    • Immunology
    • Rheumatology
    • Infectious Diseases

    Background:

    • Biologic therapies, particularly TNF-α inhibitors, are increasingly used for inflammatory diseases like rheumatoid arthritis.
    • These treatments can increase the risk of opportunistic infections, including tuberculosis (TB) and non-tuberculous mycobacteriosis (NTM).
    • Japan has a high prevalence of past tuberculosis exposure, raising concerns about TB reactivation with biologic use.

    Purpose of the Study:

    • To evaluate the risk of tuberculosis complications in patients receiving biologics for inflammatory diseases.
    • To assess the effectiveness of preventive strategies for tuberculosis in this patient population.
    • To explore the safety and potential benefits of biologic administration in cases of non-tuberculous mycobacteriosis.

    Main Methods:

    • Analysis of post-marketing surveillance data in Japan.
    • Review of clinical cases involving tuberculosis and non-tuberculous mycobacteriosis in patients on biologics.
    • Evaluation of screening protocols for latent tuberculosis infection (LTBI) and prophylactic anti-tuberculosis drug administration.

    Main Results:

    • Screening for LTBI and preemptive anti-tuberculosis treatment significantly reduced tuberculosis incidence in patients initiating TNF-α inhibitors.
    • Despite prophylaxis, some patients developed severe, fatal tuberculosis, potentially due to immune reconstitution inflammatory syndrome (IRIS).
    • Non-tuberculous mycobacteriosis (NTM) is increasing, and while previously contraindicated, biologics may be cautiously administered under specific conditions.

    Conclusions:

    • Prophylactic measures are effective but not fully protective against tuberculosis reactivation during biologic therapy.
    • Management of potential IRIS is critical, possibly requiring re-administration or continuous use of biologics.
    • Biologic therapy for NTM may be feasible in select cases, warranting further investigation.